Archived: Coastal Care North East Redcar and Cleveland

Coastal Care North East Redcar and Cleveland is a domiciliary care agency providing care to people in their own homes. At the time of the inspection there were 42 people in receipt of personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People were extremely satisfied with the service and felt staff always went above and beyond in delivering the care. They described the little extras staff just did as a part of their job. Staff were passionate about providing good care outcomes and took ownership for their practice.

There were enough staff on duty to cover the care packages. Staff reported the rotas were very well organised and enabled them to easily travel to deliver each care package and have enough time to properly support people. Recruitment practices met legal requirements and the registered manager used a variety of effective strategies to encourage people to apply to work at the service.

Medicines management was effective and closely monitored. Staff who administered medicines had the appropriate training.

The staff used the assessments as the basis for the care records and ensured these fully captured people's need. When necessary, external professionals were involved in individual people’s care. Risk assessments were clear and readily identified how to mitigate them. Staff were familiar with these documents and the actions they needed to take.

Staff had received mandatory and condition-specific training. Staff supervision sessions were regularly completed, as well as spot checks and competency assessments. Staff had received training around the Mental Capacity Act 2005 and associated code of practice and felt confident applying this in their practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff took steps to safeguard people and promote their human rights.

The management team had created an extremely robust governance system, which rapidly identified the smallest of issue, which was then quickly addressed. The registered manager critically reviewed the service and proactively looked at how improvements could be made. Staff told us that the registered manager was approachable and listened to their views. People felt the registered manager was running a good service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 9 December 2021).

At the time we found the service had addressed breaches found during the July 2021 inspection, but it was too early to determine if these improvements would be sustained. At this inspection we found the improvements had led to the service safely and effectively meeting people’s needs.

At our last inspection we recommended that kept staff COVID-19 testing under review to ensure best practice and government guidance is followed. At this inspection we found the provider had made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to the key questions safe, effective and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Coastal Care North East Redcar and Cleveland on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Coastal Care North East Redcar and Cleveland is a domiciliary care agency providing care to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection there were 42 people in receipt of personal care.

People’s experience of using this service and what we found

People and staff continued to give mixed feedback about the service. Some people told us they were not informed when call times changed or when different staff would be coming to their home. We have made a recommendation about this. Some staff felt the registered manager did not always listen to their views and some felt under pressure to pick up additional shifts. We have made a recommendation about this. Other feedback we received did acknowledge improvements were being made and nobody reported a missed call.

We identified inconsistencies with COVID-19 testing amongst staff. We have made a recommendation about this.

The newly registered manager had good oversight of the service. A new system of audits had been introduced and was working well. Where concerns were identified, appropriate action was taken. Relationships with external professionals was good and the provider had been working closely with the local authority. The registered manager had an understanding of their duty to inform CQC of certain events.

Risks were identified. Care records and risk assessments gave staff detailed guidance on minimising risk. People told us they felt safe when receiving their care. Medicines were managed safely, and changes had been made to identify any issues as soon as possible. Staff training had increased, and staff told us they had seen an improvement in this area.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 27 July 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We carried out an unannounced inspection of this service on 24 and 28 May 2021. Multiple breaches of legal requirements were found. After the last inspection we issued two warning notices in respect of good governance and safe care and treatment. The provider also completed an action plan to show what they would do and by when to improve staffing and safeguarding people from abuse and improper treatment.

We undertook this focused inspection to check whether the warning notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked whether they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Coastal Care North East Redcar and Cleveland on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Costal Care North East Redcar is a domiciliary care agency providing care to children, young adults and older adults in their own homes in the Redcar and Cleveland area. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection 50 people received personal care.

People’s experience of using this service and what we found

Risk was not identified, monitored and reviewed safely. There were no protocols in place for complex risks to support staff to care for people safely. Medicines were not safely managed. Some staff lacked the necessary training they needed to care for people safely. A survey in September 2020 demonstrated people were happy with their care and the times of their calls. During inspection, people said they remained happy with their care, however did not receive their calls on time and some people said they did not have a choice about the staff involved in their care.

There was a lack of management oversight of the service. Limited quality assurance measures were in place and these were not effective in identifying where changes needed to be made. The Commission was not always notified of changes or incidents taking place. People and staff gave mixed reviews about communication from the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 February 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an announced comprehensive inspection of this service on 20 February 2020, and breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Coastal Care North East Redcar on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s care, medicines, safeguarding, training, leadership, quality assurance and oversight of the service. We also identified breaches in relation to changes and incidents taking place at the service which we were not notified about. In addition, the provider had failed to display their ratings from their previous inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Carewatch Redcar and Cleveland is a domiciliary care service providing personal care to 83 people in their own homes.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Medicines were not always managed safely and accurate medicines records were not kept. Although people told us they felt safe, risk assessments were not always in place. Therefore, staff did not have all the information necessary to minimise risk.

There were enough staff to meet people’s needs. People told us staff were sometimes late to calls and did not always call to let them know. Staff were not always given the opportunity to meet people before attending care calls. They also did not always have all the necessary information they needed about the person in advance.

New staff were not always recruited appropriately. The provider had not always obtained a full employment history from staff before hiring them but was conducting other pre-employment checks.

The provider did not ensure care plans contained relevant information. They did not include full details of people's health needs and conditions, their preferences and views in relation to their care. This meant staff did not have access to all the information necessary to provide safe care.

The provider’s quality assurance checks had not identified errors in records or missing information.

Staff had the skills and knowledge to meet people’s care needs. Staff training was being reviewed and updated and a new training officer had been appointed to oversee this. Staff supervision meetings had not been happening regularly but the new management team were addressing this. Staff we spoke with felt supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider was not correctly recording mental capacity assessments or best interest decisions. We have made a recommendation about this.

The provider worked with other agencies to ensure they received professional advice and support when needed. Care workers respected and promoted people's privacy and dignity. Complaints were handled appropriately.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 January 2019). The service remains rated requires improvement. This service has now been rated requires improvement for two consecutive inspections.

At the last inspection there were breaches of two regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of two regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to managing risk, safe management of medicines and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Carewatch Redcar and Cleveland is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. At the time of inspection, there were 88 people using the service.

The service had a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was not present and was in the process of deregistering and a replacement manager was in post at the service during our inspection and had begun registering with us.

Medicines were not always, recorded or managed safely. We found issues with the records and auditing of medicines. Staff training regarding medicines was not up to date.

A programme of audits were carried out by the manager. However, these were not always effective as we found issues with medicines that were not identified in audits.

Communication systems were in place for staff and team meetings. However, these were not recorded. We made a recommendation to keep records of outcomes following staff meetings.

Accidents and incidents were recorded in various places however, there were no robust monitoring or recording systems in place to monitor accidents and incidents.

Feedback from people regarding the management of the service was mixed however feedback from staff was positive and they felt supported.

People’s nutrition and hydration needs were met and they were supported to maintain a healthy diet. Where needed, records to support this were detailed.

Partnership working was in place with other professionals, including health care professionals and community nurses. Specialist consultants were involved in people’s care, as and when this was needed.

People’s personal risks had been identified and more detailed risk assessments had been written to give staff the necessary guidance on how to keep people safe.

Staff training reflected people’s needs. Staff gave us positive feedback about their training.

People were supported by sufficient numbers of staff to meet their needs. Rotas’ showed there were consistent numbers of staff to meet people’s needs.

People were supported to access information in a variety of formats and adaptations could be made to suit individual needs.

People were supported by kind and caring staff. The feedback from people and their relatives was positive about the staff attitude and their caring nature.

Staff were employed safely and pre-employment checks were carried out on staff before they began working in the service. Staff were supported through an induction period. They received training and supervision from the manager together with an annual appraisal.

People were supported to maintain their independence by staff who understood and valued the importance of this.

Care plans were person centred regarding people’s preferences and were personalised. Person centred means that a person’s preferences are respected and valued when planning and delivering their care and support.

People could complain if they wished to and procedures were in place to support this.

No-one was receiving end of life are at the time of our inspection however, arrangements were in place for people.

People were supported to have maximum choice and control of their lives and staff supported them in their own homes in the least restrictive way possible; the policies and systems in the service supported this practice.

Notifications of significant events were submitted to us in a timely manner by the manager.

We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These relate to safe care and treatment and the management of medicines and good governance. You can see what action we told the provider to take at the back of the full version of this report.